Durable Power of Attorney Example - Massachusetts

-iii-
"Cardiopulmonary resuscitation (CPR)." (If you would like CPR in some but not all
circumstances when you are terminally ill, you should try to be still more specific: for example,
you might write "CPR if cardiopulmonary arrest has been caused by my terminal illness or a
complication of it." This would mean that you would still get CPR if, for example, you were the
victim of smoke inhalation in a fire.) "Organ transplants." (Again, you could be still more
specific, rejecting, for example, just a "heart transplant.")
"Surgery that would not cure me, would not improve either my mental or my physical
condition, would not make me more comfortable, and would not help me to have less pain, but
would only keep me alive longer."
"A treatment that will itself cause me severe, intractable, and long-lasting pain but will
not cure me."
Pain Relief
Under the "General Presumption for Life," of your Will to Live, you will be given
medication necessary to control any pain you may have "as long as the medication is not used in
order to cause my death." This means that you may be given pain medication that has the
secondary, but unintended, effect of shortening your life. If this is not your wish, you may want
to write something like one of the following under the third set of "Special Conditions" (the
section for conditions you describe yourself):
"I would like medication to relieve my pain but only to the extent the medication would
not seriously threaten to shorten my life." OR
"I would like medication to relieve my pain but only to the extent it is known, to a
reasonable medical certainty, that it will not shorten my life."
Think carefully about any special conditions you decide to write in your "Will to Live."
You may want to show them to your intended agent and a couple of other people to see if they
find them clear and if they mean the same thing to them as they mean to you. Remember that
how carefully you write may literally be a matter of life or death--your own.
AFTER WRITING DOWN YOUR SPECIAL CONDITIONS, IF ANY, YOU SHOULD MARK OUT
THE REST OF THE BLANK LINES LEFT ON THE FORM FOR THEM (JUST AS YOU DO AFTER
WRITING OUT THE AMOUNT ON A CHECK) TO PREVENT ANY DANGER THAT SOMEBODY OTHER
THAN YOU COULD WRITE IN SOMETHING ELSE.
IT IS WISE TO REVIEW YOUR WILL TO LIVE PERIODICALLY TO ENSURE THAT IT STILL
GIVES THE DIRECTIONS YOU WANT FOLLOWED.
Robert Powell Center for Medical Ethics
National Right to Life
www.nrlc.org ~ (202) 378-8862
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